Patient preferences and treatment safety for uncomplicated vulvovaginal candidiasis in primary health care

<p>Abstract</p> <p>Background</p> <p>Vaginitis is a common complaint in primary care. In uncomplicated candidal vaginitis, there are no differences in effectiveness between oral or vaginal treatment. Some studies describe that the preferred treatment is the oral one, but a Cochrane's review points out inconsistencies associated with the report of the preferred way that limit the use of such data. Risk factors associated with recurrent vulvovaginal candidiasis still remain controversial.</p> <p>Methods/Design</p> <p>This work describes a protocol of a multicentric prospective observational study with one year follow up, to describe the women's reasons and preferences to choose the way of administration (oral vs topical) in the treatment of not complicated candidal vaginitis. The number of women required is 765, they are chosen by consecutive sampling. All of whom are aged 16 and over with vaginal discharge and/or vaginal pruritus, diagnosed with not complicated vulvovaginitis in Primary Care in Madrid.</p> <p>The main outcome variable is the preferences of the patients in treatment choice; secondary outcome variables are time to symptoms relief and adverse reactions and the frequency of recurrent vulvovaginitis and the risk factors. In the statistical analysis, for the main objective will be descriptive for each of the variables, bivariant analysis and multivariate analysis (logistic regression).. The dependent variable being the type of treatment chosen (oral or topical) and the independent, the variables that after bivariant analysis, have been associated to the treatment preference.</p> <p>Discussion</p> <p>Clinical decisions, recommendations, and practice guidelines must not only attend to the best available evidence, but also to the values and preferences of the informed patient.</p

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Avaliação de amadurecimento de 'Ortanique' (Citrus reticulata Blanco x Citrus sinensis (L) Osbeck) em árvore por SW-NIR modelos de calibração baseados em espectroscopia

The aim of this study was the non-destructive assessment of ‘Ortanique’ (Citrus reticulata Blanco x Citrus sinensis (L) Osbeck) ripening, based on the prediction of internal quality attributes (IQA) by short-wave near-infrared reflectance spectroscopy (SW-NIRS) calibration models. Spectra from fruit of 50 trees located in two different orchards, were acquired on tree using a customized portable visible near-infrared (vis-NIR) system. Partial least squares (PLS) was used to build the various IQA calibration models. The models were tested through internal validation (IV) and external validation (EV). Generally, the IV results were always superior to those of EV: regarding IV, a high regression coefficient (R2) and low root mean square error of prediction (RMSEP) were achieved, revealing a good predictive performance for juice pH (R2 = 0.80; RMSEP = 0.10; SDR = 2.23), soluble solids content (SSC) (R2 = 0.79; RMSEP = 0.75 %; SDR = 2.27), titratable acidity (TA) (R2 = 0.73; RMSEP = 0.24 % citric acid; SDR = 1.94) and the maturation index (MI) (R2 = 0.80; RMSEP = 1.38; SDR = 2.2). The best EV predictions were obtained for TA (R2 = 0.69; RMSEP = 0.38 % citric acid; SDR = 1.24), and MI (R2 = 0.69; RMSEP = 2.07; SDR = 1.49). Calibration models for glucose, fructose and sucrose showed medium-coarse predictions for both validation strategies. A detailed investigation of MI models was performed, to understand the causes of their poor EV results. In the context of EV, model updating strategies were explored by using some validation samples to improve the calibration model. The methods of bias correction and spiking were tested, showing a clear improvement in the predictions.info:eu-repo/semantics/publishedVersio

A moderna diferença: studies in identity

Fundação para a Ciência e a Tecnologi

Whole-genome sequencing as a tool for studying the microevolution of drug-resistant serial Mycobacterium tuberculosis isolates

Treatment of drug-resistant tuberculosis requires extended use of more toxic and less effective drugs and may result in retreatment cases due to failure, abandonment or disease recurrence. It is therefore important to understand the evolutionary process of drug resistance in Mycobacterium tuberculosis. We here in describe the microevolution of drug resistance in serial isolates from six previously treated patients. Drug resistance was initially investigated through phenotypic methods, followed by genotypic approaches. The use of whole-genome sequencing allowed the identification of mutations in the katG, rpsL and rpoB genes associated with drug resistance, including the detection of rare mutations in katG and mixed populations of strains. Molecular docking simulation studies of the impact of observed mutations on isoniazid binding were also performed. Whole-genome sequencing detected 266 single nucleotide polymorphisms between two isolates obtained from one patient, suggesting a case of exogenous reinfection. In conclusion, sequencing technologies can detect rare mutations related to drug resistance, identify subpopulations of resistant strains, and identify diverse populations of strains due to exogenous reinfection, thus improving tuberculosis control by guiding early implementation of appropriate clinical and therapeutic interventions.JLCGD was a Fellow of Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), PEAS is a Fellow of Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) productivity. The study had financial support by Project CNPq/Universal (401963/2016–0), CAPES (PVE-CAPES, 88881.064961/2014–01) and Fundação para a Ciência e Tecnologia (FCT), Portugal [UID/DTP/04138/2019]. This work was carried out with the support of the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil (CAPES) to working mission within the scope of the Capes-Print Program, Financing Code 001". JP was supported by FCT through Estímulo Individual ao Emprego Científico [CEECIND/00394/2017]. JEP is funded by a Newton Institutional Links Grant (British Council, no. 261868591). TGC is funded by the Medical Research Council UK (Grant no. MR/M01360X/1, MR/N010469/1, MR/R025576/1, and MR/R020973/1) and BBSRC (Grant no. BB/R013063/1). SC is funded by Medical Research Council UK grants (ref. MR/M01360X/1, MR/R025576/1, and MR/R020973/1). AP is funded by a faculty baseline fund (BAS/1/1020-01-01) from KAUST.info:eu-repo/semantics/publishedVersio

Resumos concluídos - Ciências Biológicas

Resumos concluídos - Ciências Biológica